CILIARY BODY NEURILEMOMA - UNUSUAL CLINICAL FINDINGS INTIMATING THE DIAGNOSIS

Background: Neurilemomas (schwannomas) rarely occur intraocularly. Whe n present, they pose a diagnostic dilemma for the physician and often are mistaken as a malignant lesion, resulting in enucleation. Methods: The authors report the clinical findings of a 46-year-old man with a slowly progressive growing mass of the anterior chamber, associated wi th glaucoma and the development of cataract. To further delineate the tumor's features, ancillary techniques, including ultrasonography, com puted tomography, and magnetic resonance imaging, were conducted. A de finitive anterior chamber biopsy of the tumor was performed with histo logic examination and electron microscopy. Results: Ultrasonography, h igh-resolution computed tomography and magnetic resonance imaging show ed a well-delineated mass of the inferior ciliary body involving nearl y 5 clock hours of the angle. Two clinical features that suggested a l ongstanding tumor were brilliant transillumination of the mass (leadin g to the impression of a ''cystic mass,'' not corroborated by ultrason ography) and retrodisplacement of the involved iris root. The histolog y, and particularly the electron microscopic features, confirmed the d iagnosis of a neurilemoma, a benign tumor of the anterior segment. Con clusion: Intraocular neurilemomas are extremely rare tumors. Few are w ell documented with modern ancillary techniques. Clinical findings in conjunction with radiographic and ultrasonic features may support the diagnosis of a benign tumor. For this patient, confirmation via biopsy permitted combined cataract and glaucoma surgery to rehabilitate the eye, which retains 20/20 visual acuity 3 years after the procedure.